Limitation on Definition of "Preexisting Condition"

  1. Law
  2. Georgia Code
  3. Insurance
  4. Insurance Generally
  5. General Provisions
  6. Limitation on Definition of "Preexisting Condition"

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  1. As used in this Code section, the term:
    1. "Preventive services" means screening tests, counseling, and preventive medicines, or treatments provided or conducted to prevent medical illness or condition prior to symptoms or physical manifestations of such medical illness or condition.
    2. "Short-term health benefit policy or certificate" means any individual or group plan, policy, or contract for health care services for a coverage period of less than one year issued, delivered, issued for delivery, or renewed in this state which provides major medical benefits by a health care corporation, health maintenance organization, preferred provider organization, accident and sickness insurer, fraternal benefit society, or any similar entity and any self-insured plan not subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1101, et seq.
  2. No short-term health benefit policy or certificate shall contain a provision defining "preexisting condition" which is more restrictive than the following:
    1. Preexisting condition means the existence of symptoms which would cause an ordinary prudent person to seek diagnosis, care, or treatment; or
    2. A condition for which medical advice or treatment was recommended by or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person.The condition at issue must be the ultimate condition for which medical advice or treatment was recommended by or received from a provider of health care services and excludes any preventive services.

(Code 1981, §33-24-59.26, enacted by Ga. L. 2019, p. 386, § 64/SB 133.)

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 2019, Code Section 33-24-59.25, as enacted by Ga. L. 2019, p. 386, § 64/SB 133, was redesignated as Code Section 33-24-59.26.

RESEARCH REFERENCES

Am. Jur. 2d.

- 43 Am. Jur. 2d, Insurance, § 551 et seq.


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